Dietary Potassium Intake and Serum Potassium in the Chronic Renal Insufficiency Cohort Study

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Background: Dietary potassium restriction is often recommended for patients with advanced chronic kidney disease (CKD) to reduce the risk of hyperkalemia. However, restricting potassium-rich foods is inconsistent with healthy eating patterns; furthermore, few studies have examined the relationship between dietary potassium intake and serum potassium in CKD patients. Methods: We conducted a prospective analysis of 2957 participants in the Chronic Renal Insufficiency Cohort Study. Total dietary potassium intake (tertiles of mg/1000kcal) and consumption of potassium-rich foods (servings/1000kcal) were derived from Diet History Questionnaire responses. Serum potassium (mmol/L) was analyzed continuously, with hyperkalemia defined as the first occurrence of serum potassium >5.0 mmol/L. Linear mixed-effects regression models were used to examine the association of dietary potassium intake and potassium-rich food groups with serum potassium over time. Analyses were stratified by baseline eGFR levels (<45 and ≥45 mL/min/1.73 m2), diabetes, and congestive heart failure (CHF) status. Results: The incidence rate of hyperkalemia was 4.1, 4.2, and 4.5 cases per 100 person-years for participants with low, medium, and high potassium intake, respectively. The incidence of hyperkalemia was approximately twice as high in participants with lower vs. higher baseline eGFR, and in those with vs. without baseline diabetes. High dietary potassium intake was not associated with higher serum potassium (β = 0.00 [95% CI: -0.04, 0.03] and 0.01 [95%CI: -0.02, 0.04] for medium vs. low and high vs. low intake levels, respectively). This pattern did not differ by baseline diabetes (p-interaction = 0.98) or CHF status (p-interaction = 0.06). There was no significant association between high vs. low dietary potassium and serum potassium in either eGFR category. In food group analysis, higher consumption of oranges/juice and cantaloupe was associated with lower serum potassium (β = -0.03, [95%CI: -0.06, -0.00]). Conclusion: Higher total dietary potassium intake and consumption of potassium-rich foods were not associated with elevated serum potassium over time among CKD patients, even in the presence of lower eGFR level, diabetes, or CHF at baseline. Funding: NIDDK Support - NIDDK Support, NIDDK Support

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